The issue of how to deliver culturally appropriate mental healthcare has attracted national attention as more members of minority racial/ethnic groups are increasingly establishing residence in rural communities. For example, a recent United States Department of Agriculture report indicates that the Hispanic/Latino population in rural and frontier America has nearly doubled from 1.4 to 2.7 million, and is now the most rapidly growing segment of the population in nonmetropolitan counties.1
Culture is known to influence a number of aspects of an individual's healthcare, including approaches to advanced directives, preferences for differing treatments, and individual health beliefs, as well as attitudes toward autopsy, organ donations, and the disclosure of medical information.2
Also, a physician's cultural background may influence the interaction between themselves and a patient, potentially affecting patient access, use, treatment, quality, and outcomes.2
The delivery of culturally appropriate mental healthcare is particularly relevant in rural populations. Rural communities are burdened with limited access to mental healthcare specialty resources, never mind resources relevant to language or culture, which in itself can foster a culture of isolation. This cultural/geographical remoteness often creates a culture of fierce independence, which frequently manifests itself in grievances that are reflected in rural mental health literature.3
This includes angry protests/calls for greater support for increased mental healthcare resources (such as specialty services and parity in mental health reimbursement) and complaints about the relatively low quality of treatment received by rural people, which result in poor outcomes. As a response to these calls for additional mental health resources, and improved healthcare access, there have been a number of influential reports identifying information technology as potentially offering at least a partial solution.4,5
However, with the exception of Goal Six—“Technology Is Used to Access Mental Healthcare and Information”—in the President's Mental Health Report, there has been little time spent in these various reports considering how technology can help solve these problems.4
Unfortunately, little is known about how to deliver “culturally appropriate e-mental healthcare,” or even whether or not this is particularly different from the delivery of culturally appropriate mental healthcare delivered face-to-face in an office setting. Cultural differences may be more challenging during electronic consultations via videoconferencing, e-mail, or telephone, compared to face-to-face consultations. As the practice of e-mental health becomes more pervasive, it may be that managing cultural views and perspectives via technology will be even more important. To date, there has been a paucity of research concerning the provision of culturally appropriate mental healthcare, especially at a distance, and much of the completed research has been done with small samples and has employed weak experimental designs, with only a few exceptions.6–9
The goal of this paper is to review relevant research issues in the provision of culturally appropriate e-mental healthcare and make recommendations for expanding and prioritizing research efforts in this area. This work is an outgrowth of a National Institute of Mental Health (NIMH) workshop on e-mental health. The paper begins with a brief discussion of the workshop and defining “culturally appropriate” care, it then turns to a review and discussion of culturally appropriate e-mental care, and concludes with recommendations for future directions.